<!DOCTYPE html>
<!--suppress ALL-->
<html lang="en" xmlns:th="http://www.thymeleaf.org">
<div th:replace="pages/admin/commons/header :: header"></div>
<body style="background-color:#fff">
<div class="wap-container">
    <div class="panel">
        <div class="panel-body">
            <form style="margin-left: 15%" action="/childhealth/neonatalVisit/data-upd"
                  method="post"
                  class="form form-horizontal"
                  id="form-member-add">
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>基本资料</b></label>
                <div class="row clearfix">
                    <br><br><br>
                    <input type="hidden" th:value="${type} == toUpd ? 'upd' : 'add'" name="type">

                    <input type="hidden" th:if="${result.id} != 0" th:value="${result.id}" name="id">
                    <input type="hidden" th:if="${result.id} == 0" name="id">

                </div>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>姓名：</label>
                <div class="form-controls col-xs-8 col-sm-9">

                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xm}"
                           name="xm">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0" placeholder="姓名"
                           name="xm">

                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>性别：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xb}"
                           name="xb">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="性别"
                           name="xb">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生日期：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.csrq}"
                           name="csrq">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生日期"
                           name="csrq">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>访视时间：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="fssj">
                                    <option value=""></option>
                                    <option value="入户">入户</option>
                                    <option value="门诊">门诊</option>
                                    <option value="电话">电话</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <HR style=" border:1px dashed #334455">
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>出生情况</b></label>
                <div class="row clearfix">
                    <br><br><br>
                </div>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>日龄：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.rl}"
                           name="rl">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="日龄"
                           name="rl">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>身份证类型：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.sfzlx}"
                           name="sfzlx">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="身份证类型"
                           name="sfzlx">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>身份证号码：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.sfzhm}"
                           name="sfzhm">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="身份证号码"
                           name="sfzhm">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>归属单位：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.gsdw}"
                           name="gsdw">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="归属单位"
                           name="gsdw">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>免费：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mf}"
                           name="mf">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="免费"
                           name="mf">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>户口地：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.hkd}"
                           name="hkd">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="户口地"
                           name="hkd">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>现住址：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xzz}"
                           name="xzz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="现住址"
                           name="xzz">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>父亲姓名：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fqxm}"
                           name="fqxm">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="父亲姓名"
                           name="fqxm">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>父亲职业：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="fqzy">
                                    <option value=""></option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>父亲联系电话：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fqlxdh}"
                           name="fqlxdh">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="父亲联系电话"
                           name="fqlxdh">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>父亲出生日期：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fqcsrq}"
                           name="fqcsrq">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="父亲出生日期"
                           name="fqcsrq">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>母亲姓名：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqxm}"
                           name="mqxm">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="母亲姓名"
                           name="mqxm">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>母亲职业：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="mqzy">
                                    <option value=""></option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>母亲联系电话：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqlxdh}"
                           name="mqlxdh">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="母亲联系电话"
                           name="mqlxdh">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>母亲出生日期：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.mqcsrq}"
                           name="mqcsrq">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="母亲出生日期"
                           name="mqcsrq">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生孕周：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.csyz}"
                           name="csyz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生孕周"
                           name="csyz">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>孕期高危：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.yqgw}"
                           name="yqgw">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="孕期高危"
                           name="yqgw">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>孕期患病：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    无
                    <input th:if="${result.id} != 0" type="checkbox" name="w"
                           th:checked="${result.w} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="w">
                    &nbsp;&nbsp;
                    糖尿病
                    <input th:if="${result.id} != 0" type="checkbox" name="tnb"
                           th:checked="${result.tnb} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="tnb">
                    &nbsp;&nbsp;
                    妊娠期高血压
                    <input th:if="${result.id} != 0" type="checkbox" name="rsqgxy"
                           th:checked="${result.rsqgxy} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="rsqgxy">
                    &nbsp;&nbsp;
                    其他
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.qt}"
                           name="qt">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="其他"
                           name="qt">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>助产机构：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.zcjg}"
                           name="zcjg">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="助产机构"
                           name="zcjg">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生情况：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    顺产
                    <input th:if="${result.id} != 0" type="checkbox" name="sc"
                           th:checked="${result.sc} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="sc">
                    &nbsp;&nbsp;
                    胎头吸引
                    <input th:if="${result.id} != 0" type="checkbox" name="ttxy"
                           th:checked="${result.ttxy} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="ttxy">
                    &nbsp;&nbsp;
                    产钳
                    <input th:if="${result.id} != 0" type="checkbox" name="cq"
                           th:checked="${result.cq} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="cq">
                    &nbsp;&nbsp;
                    剖宫
                    <input th:if="${result.id} != 0" type="checkbox" name="pg"
                           th:checked="${result.pg} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="pg">
                    &nbsp;&nbsp;
                    双多胎
                    <input th:if="${result.id} != 0" type="checkbox" name="sdt"
                           th:checked="${result.sdt} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="sdt">
                    &nbsp;&nbsp;
                    臀位
                    <input th:if="${result.id} != 0" type="checkbox" name="tw"
                           th:checked="${result.tw} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="tw">
                    &nbsp;&nbsp;
                    其他
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.qt2}"
                           name="qt2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="其他"
                           name="qt2">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>新生儿窒息：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="xsezx">
                                    <option value=""></option>
                                    <option value="无">无</option>
                                    <option value="轻">轻</option>
                                    <option value="中">中</option>
                                    <option value="重">重</option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>阿氏评分：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    不详
                    <input th:if="${result.id} != 0" type="checkbox" name="aspfbx"
                           th:checked="${result.aspfbx} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="aspfbx">
                    &nbsp;&nbsp;
                    1分钟
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.aspf1fz}"
                           name="aspf1fz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="1分钟"
                           name="aspf1fz">
                    5分钟
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.aspf5fz}"
                           name="aspf5fz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="5分钟"
                           name="aspf5fz">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>畸形：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="jx">
                                    <option value=""></option>
                                    <option value="无">无</option>
                                    <option value="有">有</option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>新生儿听力筛查：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="xsetlsc">
                                    <option value=""></option>
                                    <option value="通过">通过</option>
                                    <option value="未通过">未通过</option>
                                    <option value="未筛查">未筛查</option>
                                    <option value="不详">不详</option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>新生儿疾病筛查：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    未进行
                    <input th:if="${result.id} != 0" type="checkbox" name="xsejbscwjx"
                           th:checked="${result.xsejbscwjx} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="xsejbscwjx">
                    &nbsp;&nbsp;
                    检查均阴性
                    <input th:if="${result.id} != 0" type="checkbox" name="xsejbscjcjyx"
                           th:checked="${result.xsejbscjcjyx} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="xsejbscjcjyx">
                    &nbsp;&nbsp;
                    甲低
                    <input th:if="${result.id} != 0" type="checkbox" name="xsejbscjd"
                           th:checked="${result.xsejbscjd} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="xsejbscjd">
                    &nbsp;&nbsp;
                    苯丙酮尿症
                    <input th:if="${result.id} != 0" type="checkbox" name="xsejbscbbtnz"
                           th:checked="${result.xsejbscbbtnz} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="xsejbscbbtnz">
                    &nbsp;&nbsp;
                    其他遗传性代谢病
                    <input th:if="${result.id} != 0" type="checkbox" name="xsejbscqtycxdxb"
                           th:checked="${result.xsejbscqtycxdxb} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="xsejbscqtycxdxb">
                    &nbsp;&nbsp;
                    <input style="width: 25%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xsejbscqtycxdxb2}"
                           name="xsejbscqtycxdxb2">
                    <input style="width: 25%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="xsejbscqtycxdxb2">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生身长(cm)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.cssc}"
                           name="cssc">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生身长(cm)"
                           name="cssc">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>出生体重(g)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.cstz}"
                           name="cstz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="出生体重(g)"
                           name="cstz">
                </div>
                <br><br><br>


                <HR style=" border:1px dashed #334455">
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span><b>访视内容</b></label>
                <div class="row clearfix">
                    <br><br><br>
                </div>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>体重(kg)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.tz}"
                           name="tz">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="体重"
                           name="tz">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>体重评价：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.tzpj1}"
                           name="tzpj1">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="tzpj1">
                    &nbsp;
                    &nbsp;
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.tzpj2}"
                           name="tzpj2">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="tzpj2">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>身长(cm)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.sc2}"
                           name="sc2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="身长(cm)"
                           name="sc2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>身长评价：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.scpj1}"
                           name="scpj1">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="scpj1">
                    &nbsp;
                    &nbsp;
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.scpj2}"
                           name="scpj2">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="scpj2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>H/A评价：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.hapj1}"
                           name="hapj1">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="hapj1">
                    &nbsp;
                    &nbsp;
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.hapj2}"
                           name="hapj2">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="hapj2">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>喂养方式：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="wyfs">
                                    <option value=""></option>
                                    <option value="纯母乳">纯母乳</option>
                                    <option value="混合">混合</option>
                                    <option value="人工">人工</option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>吃奶量(ml/次)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.cnl}"
                           name="cnl">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="吃奶量(ml/次)"
                           name="cnl">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>吃奶次数(次/日)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.cncs}"
                           name="cncs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="吃奶次数(次/日)"
                           name="cncs">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>呕吐：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="ot">
                                    <option value=""></option>
                                    <option value="无">无</option>
                                    <option value="有">有</option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>大便：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="db">
                                    <option value=""></option>
                                    <option value="模糊">模糊</option>
                                    <option value="稀">稀</option>
                                    <option value="其他">其他</option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>大便次数(次/日)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.dbcs}"
                           name="dbcs">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="大便次数(次/日)"
                           name="dbcs">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>体温(℃)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.tw2}"
                           name="tw2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="体温(℃)"
                           name="tw2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>心率(次/分)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xl}"
                           name="xl">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="心率(次/分)"
                           name="xl">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>呼吸(次/分)：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.hx}"
                           name="hx">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="呼吸(次/分)"
                           name="hx">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>面色：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="ms1">
                                    <option value=""></option>
                                    <option value="红润">红润</option>
                                    <option value="黄染">黄染</option>
                                    <option value="其他">其他</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.ms2}"
                           name="ms2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="ms2">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>黄疸部位：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    无
                    <input th:if="${result.id} != 0" type="checkbox" name="hdbww"
                           th:checked="${result.hdbww} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="hdbww">
                    &nbsp;&nbsp;
                    面部
                    <input th:if="${result.id} != 0" type="checkbox" name="hdbwmb"
                           th:checked="${result.hdbwmb} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="hdbwmb">
                    &nbsp;&nbsp;
                    躯干
                    <input th:if="${result.id} != 0" type="checkbox" name="hdbwqg"
                           th:checked="${result.hdbwqg} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="hdbwqg">
                    &nbsp;&nbsp;
                    四肢
                    <input th:if="${result.id} != 0" type="checkbox" name="hdbwsz"
                           th:checked="${result.hdbwsz} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="hdbwsz">
                    &nbsp;&nbsp;
                    手足
                    <input th:if="${result.id} != 0" type="checkbox" name="hdbwsz2"
                           th:checked="${result.hdbwsz2} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="hdbwsz2">
                    &nbsp;&nbsp;
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>前卤：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.ql1}"
                           name="ql1">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="ql1">
                    &nbsp;
                    cm ×
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.ql2}"
                           name="ql2">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="ql2">&nbsp;cm

                    <span class="select-box" style="width: 20%;">
                                <select class="select" name="ql3">
                                    <option value=""></option>
                                    <option value="正常">正常</option>
                                    <option value="膨隆">膨隆</option>
                                    <option value="凹陷">凹陷</option>
                                    <option value="其他">其他</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;

                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.ql4}"
                           name="ql4">
                    <input style="width: 13%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="ql4">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>眼睛：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="yj1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.yj2}"
                           name="yj2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="yj2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>儿外观：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="ewg1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.ewg2}"
                           name="ewg2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="ewg2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>鼻外观：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="bwg1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.bwg2}"
                           name="bwg2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="bwg2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>口腔：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="kq1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.kq2}"
                           name="kq2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="kq2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>心肺听诊：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="xftz1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xftz2}"
                           name="xftz2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="xftz2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>腹部触诊：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="fbcz1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fbcz2}"
                           name="fbcz2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="fbcz2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>外生殖器：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="wszq1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.wszq2}"
                           name="wszq2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="wszq2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>四肢活动：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="szhd1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.szhd2}"
                           name="szhd2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="szhd2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>颈部包块：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="jbbk1">
                                    <option value=""></option>
                                    <option value="无">无</option>
                                    <option value="有">有</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jbbk2}"
                           name="jbbk2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="jbbk2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>皮肤：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="pf1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="湿疹">湿疹</option>
                                    <option value="糜烂">糜烂</option>
                                    <option value="其他">其他</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.pf2}"
                           name="pf2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="pf2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>肛门：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="gm1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.gm2}"
                           name="gm2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="gm2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>胸部：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="xb1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xb2}"
                           name="xb2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="xb2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>脊柱：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="jz1">
                                    <option value=""></option>
                                    <option value="未见异常">未见异常</option>
                                    <option value="异常">异常</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jz2}"
                           name="jz2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="jz2">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>脐带：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="qd1">
                                    <option value=""></option>
                                    <option value="未脱">未脱</option>
                                    <option value="脱落">脱落</option>
                                    <option value="脐部有渗出">脐部有渗出</option>
                                    <option value="其他">其他</option>
                                </select>
                            </span>
                    &nbsp;&nbsp;
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.qd2}"
                           name="qd2">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           name="qd2">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>转诊建议：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="zzjy">
                                   <option value=""></option>
                                    <option value="无">无</option>
                                    <option value="有">有</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>原因：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.yy}"
                           name="yy">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="原因"
                           name="yy">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>机构及科室：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.jgjks}"
                           name="jgjks">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="机构及科室"
                           name="jgjks">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>下次随访日期：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xcsfrq}"
                           name="xcsfrq">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="下次随访日期"
                           name="xcsfrq">
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>指导内容：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    1 喂养
                    <input th:if="${result.id} != 0" type="checkbox" name="zdnr1"
                           th:checked="${result.zdnr1} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="zdnr1">
                    &nbsp;&nbsp;
                    2 发育
                    <input th:if="${result.id} != 0" type="checkbox" name="zdnr2"
                           th:checked="${result.zdnr2} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="zdnr2">
                    &nbsp;&nbsp;
                    3 防病
                    <input th:if="${result.id} != 0" type="checkbox" name="zdnr3"
                           th:checked="${result.zdnr3} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="zdnr3">
                    &nbsp;&nbsp;
                    4 预防伤害
                    <input th:if="${result.id} != 0" type="checkbox" name="zdnr4"
                           th:checked="${result.zdnr4} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="zdnr4">
                    &nbsp;&nbsp;
                    5 口腔保健
                    <input th:if="${result.id} != 0" type="checkbox" name="zdnr5"
                           th:checked="${result.zdnr5} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="zdnr5">
                    &nbsp;&nbsp;
                    6 其他
                    <input th:if="${result.id} != 0" type="checkbox" name="zdnr6"
                           th:checked="${result.zdnr6} == 'on'">
                    <input th:if="${result.id} == 0" type="checkbox" name="zdnr6">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>星期：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xq}"
                           name="xq">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="星期"
                           name="xq">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>预约医生：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="yyys">
                                   <option value=""></option>
                                   <option value="刘金兰">刘金兰</option>
                                   <option value="刘灯华">刘灯华</option>
                                   <option value="谭少荣">谭少荣</option>
                                   <option value="贺艳">贺艳</option>
                                   <option value="朱陈兰">朱陈兰</option>
                                   <option value="刘明">刘明</option>
                                   <option value="单位管理员">单位管理员</option>
                                   <option value="彭芬芬">彭芬芬</option>
                                   <option value="赵鹏">赵鹏</option>
                                   <option value="朱艳红">朱艳红</option>
                                   <option value="钟宏">钟宏</option>
                                   <option value="陈建兰">陈建兰</option>
                                   <option value="龙雪蓉">龙雪蓉</option>
                                   <option value="赵艳玲">赵艳玲</option>
                                   <option value="杨智华">杨智华</option>
                                   <option value="杨智华">杨智华</option>
                                   <option value="贺秋艳">贺秋艳</option>
                                   <option value="朱斐">朱斐</option>
                                   <option value="刘泽玮">刘泽玮</option>
                                   <option value="贺雪莲">贺雪莲</option>
                                   <option value="陈晓丹">陈晓丹</option>
                                   <option value="贺亚河">贺亚河</option>
                                   <option value="钟观莲">钟观莲</option>
                                   <option value="范利生">范利生</option>
                                   <option value="严勇">严勇</option>
                                   <option value="杨霞">杨霞</option>
                                   <option value="陈亮">陈亮</option>
                                   <option value="张海芳">张海芳</option>
                                   <option value="王智凤">王智凤</option>
                                   <option value="刘小肖">刘小肖</option>
                                   <option value="周艳华">周艳华</option>
                                   <option value="刘金明">刘金明</option>
                                   <option value="刘丽燕">刘丽燕</option>
                                   <option value="运维1">运维1</option>
                                   <option value="宁金">宁金</option>
                                   <option value="谢香玉">谢香玉</option>
                                   <option value="周丽">周丽</option>
                                   <option value="贺娟娟">贺娟娟</option>
                                   <option value="周小兰">周小兰</option>
                                   <option value="吴玲">吴玲</option>
                                   <option value="郭瑛">郭瑛</option>
                                   <option value="陈慧娟">陈慧娟</option>
                                   <option value="刘家裔">刘家裔</option>
                                   <option value="张雨莎">张雨莎</option>
                                   <option value="颜晓春">颜晓春</option>
                                   <option value="严小华">严小华</option>
                                   <option value="甘冰球">甘冰球</option>
                                   <option value="开发人员">开发人员</option>
                                   <option value="谢金艳">谢金艳</option>
                                   <option value="赵娜">赵娜</option>
                                   <option value="系统演示">系统演示</option>
                                   <option value="系统管理员">系统管理员</option>
                                   <option value="管理员">管理员</option>
                                </select>
                            </span>
                </div>
                <br><br><br>


                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>下次随访地点：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.xcsfdd}"
                           name="xcsfdd">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="下次随访地点"
                           name="xcsfdd">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>访视人：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="fsr">
                                   <option value=""></option>
                                   <option value="刘金兰">刘金兰</option>
                                   <option value="刘灯华">刘灯华</option>
                                   <option value="谭少荣">谭少荣</option>
                                   <option value="贺艳">贺艳</option>
                                   <option value="朱陈兰">朱陈兰</option>
                                   <option value="刘明">刘明</option>
                                   <option value="单位管理员">单位管理员</option>
                                   <option value="彭芬芬">彭芬芬</option>
                                   <option value="赵鹏">赵鹏</option>
                                   <option value="朱艳红">朱艳红</option>
                                   <option value="钟宏">钟宏</option>
                                   <option value="陈建兰">陈建兰</option>
                                   <option value="龙雪蓉">龙雪蓉</option>
                                   <option value="赵艳玲">赵艳玲</option>
                                   <option value="杨智华">杨智华</option>
                                   <option value="杨智华">杨智华</option>
                                   <option value="贺秋艳">贺秋艳</option>
                                   <option value="朱斐">朱斐</option>
                                   <option value="刘泽玮">刘泽玮</option>
                                   <option value="贺雪莲">贺雪莲</option>
                                   <option value="陈晓丹">陈晓丹</option>
                                   <option value="贺亚河">贺亚河</option>
                                   <option value="钟观莲">钟观莲</option>
                                   <option value="范利生">范利生</option>
                                   <option value="严勇">严勇</option>
                                   <option value="杨霞">杨霞</option>
                                   <option value="陈亮">陈亮</option>
                                   <option value="张海芳">张海芳</option>
                                   <option value="王智凤">王智凤</option>
                                   <option value="刘小肖">刘小肖</option>
                                   <option value="周艳华">周艳华</option>
                                   <option value="刘金明">刘金明</option>
                                   <option value="刘丽燕">刘丽燕</option>
                                   <option value="运维1">运维1</option>
                                   <option value="宁金">宁金</option>
                                   <option value="谢香玉">谢香玉</option>
                                   <option value="周丽">周丽</option>
                                   <option value="贺娟娟">贺娟娟</option>
                                   <option value="周小兰">周小兰</option>
                                   <option value="吴玲">吴玲</option>
                                   <option value="郭瑛">郭瑛</option>
                                   <option value="陈慧娟">陈慧娟</option>
                                   <option value="刘家裔">刘家裔</option>
                                   <option value="张雨莎">张雨莎</option>
                                   <option value="颜晓春">颜晓春</option>
                                   <option value="严小华">严小华</option>
                                   <option value="甘冰球">甘冰球</option>
                                   <option value="开发人员">开发人员</option>
                                   <option value="谢金艳">谢金艳</option>
                                   <option value="赵娜">赵娜</option>
                                   <option value="系统演示">系统演示</option>
                                   <option value="系统管理员">系统管理员</option>
                                   <option value="管理员">管理员</option>
                                </select>
                            </span>
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>访视单位：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.fsdw}"
                           name="fsdw">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="访视单位"
                           name="fsdw">
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>访视结果：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                            <span class="select-box" style="width: 20%;">
                                <select class="select" name="fsjg">
                                   <option value=""></option>
                                   <option value="本次访视未见异常">本次访视未见异常</option>
                                   <option value="异常">异常</option>
                                </select>
                            </span>
                </div>
                <br><br><br>

                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>录入人：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.lrr}"
                           name="lrr">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="录入人"
                           name="lrr">
                </div>
                <br><br><br>
                <label class="form-label col-xs-4 col-sm-3"><span class="c-red"></span>录入单位：</label>
                <div class="form-controls col-xs-8 col-sm-9">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} != 0"
                           th:value="${result.lrdw}"
                           name="lrdw">
                    <input style="width: 30%" type="text" class="input-text"
                           th:if="${result.id} == 0"
                           placeholder="录入单位"
                           name="lrdw">
                </div>
                <br><br><br>

                <div class="row clearfix">
                    <div class="col-xs-8 col-sm-9 col-xs-offset-4 col-sm-offset-3">
                        <button style=" margin-left: inherit" class="btn btn-primary radius" type="submit">
                            [[${type}=='toUpd'? '修改':'添加']]
                        </button>
                    </div>
                </div>
            </form>
        </div>
    </div>
</div>
<div th:replace="pages/admin/commons/footer :: footer"></div>
<script th:src="@{/layui/layui.js}" charset="utf-8"></script>
<script type="text/javascript">


    $.ajax({
        url: "/childhealth/dataDictionary/getNodeInfo/79",//查询职业
        method: "POST",
        success: function (result) {
            $.each(result.data, function (index, item) {
                var opt1 = $("<option value='" + item.value + "'></option>").append(item.value);
                var opt2 = $("<option value='" + item.value + "'></option>").append(item.value);
                $("[name=fqzy]").append(opt1);
                $("[name=mqzy]").append(opt2);
            })
            var fqzy = '[[${result.fqzy}]]';
            $("[name=fqzy] option[value= " + fqzy + "]").prop("selected", true);
            var mqzy = '[[${result.mqzy}]]';
            $("[name=mqzy] option[value= " + mqzy + "]").prop("selected", true);
        }
    });


    layui.use('laydate', function () {
        var laydate = layui.laydate;

        //执行一个laydate实例
        laydate.render({
            elem: '#test1', //指定元素
            type: 'datetime'
        });
        laydate.render({
            elem: '#test2', //指定元素
            type: 'datetime'
        });
    });


    $(function () {

        if ('[[${result.id}]]' != 0) {
            //修改时填充下拉框值
            var fssj = '[[${result.fssj}]]';
            $("[name=fssj] option[value= " + fssj + "]").prop("selected", true);
            var xsezx = '[[${result.xsezx}]]';
            $("[name=xsezx] option[value= " + xsezx + "]").prop("selected", true);
            var jx = '[[${result.jx}]]';
            $("[name=jx] option[value= " + jx + "]").prop("selected", true);
            var xsetlsc = '[[${result.xsetlsc}]]';
            $("[name=xsetlsc] option[value= " + xsetlsc + "]").prop("selected", true);
            var wyfs = '[[${result.wyfs}]]';
            $("[name=wyfs] option[value= " + wyfs + "]").prop("selected", true);
            var ot = '[[${result.ot}]]';
            $("[name=ot] option[value= " + ot + "]").prop("selected", true);
            var db = '[[${result.db}]]';
            $("[name=db] option[value= " + db + "]").prop("selected", true);
            var ms1 = '[[${result.ms1}]]';
            $("[name=ms1] option[value= " + ms1 + "]").prop("selected", true);
            var ms1 = '[[${result.ms1}]]';
            $("[name=ms1] option[value= " + ms1 + "]").prop("selected", true);
            var ql3 = '[[${result.ql3}]]';
            $("[name=ql3] option[value= " + ql3 + "]").prop("selected", true);
            var yj1 = '[[${result.yj1}]]';
            $("[name=yj1] option[value= " + yj1 + "]").prop("selected", true);

            var ewg1 = '[[${result.ewg1}]]';
            $("[name=ewg1] option[value= " + ewg1 + "]").prop("selected", true);
            var bwg1 = '[[${result.bwg1}]]';
            $("[name=bwg1] option[value= " + bwg1 + "]").prop("selected", true);
            var kq1 = '[[${result.kq1}]]';
            $("[name=kq1] option[value= " + kq1 + "]").prop("selected", true);
            var xftz1 = '[[${result.xftz1}]]';
            $("[name=xftz1] option[value= " + xftz1 + "]").prop("selected", true);
            var fbcz1 = '[[${result.fbcz1}]]';
            $("[name=fbcz1] option[value= " + fbcz1 + "]").prop("selected", true);
            var wszq1 = '[[${result.wszq1}]]';
            $("[name=wszq1] option[value= " + wszq1 + "]").prop("selected", true);
            var szhd1 = '[[${result.szhd1}]]';
            $("[name=szhd1] option[value= " + szhd1 + "]").prop("selected", true);
            var jbbk1 = '[[${result.jbbk1}]]';
            $("[name=jbbk1] option[value= " + jbbk1 + "]").prop("selected", true);
            var pf1 = '[[${result.pf1}]]';
            $("[name=pf1] option[value= " + pf1 + "]").prop("selected", true);
            var gm1 = '[[${result.gm1}]]';
            $("[name=gm1] option[value= " + gm1 + "]").prop("selected", true);
            var xb1 = '[[${result.xb1}]]';
            $("[name=xb1] option[value= " + xb1 + "]").prop("selected", true);
            var jz1 = '[[${result.jz1}]]';
            $("[name=jz1] option[value= " + jz1 + "]").prop("selected", true);
            var qd1 = '[[${result.qd1}]]';
            $("[name=qd1] option[value= " + qd1 + "]").prop("selected", true);
            var zzjy = '[[${result.zzjy}]]';
            $("[name=zzjy] option[value= " + zzjy + "]").prop("selected", true);
            var yyys = '[[${result.yyys}]]';
            $("[name=yyys] option[value= " + yyys + "]").prop("selected", true);
            var fsr = '[[${result.fsr}]]';
            $("[name=fsr] option[value= " + fsr + "]").prop("selected", true);
            var fsjg = '[[${result.fsjg}]]';
            $("[name=fsjg] option[value= " + fsjg + "]").prop("selected", true);
        }
        //
        // //单选按钮默认选中查询出来的
        // var item = '[ [${result.nj}] ]';
        // var obj = document.getElementsByName("nj");
        // for (var i = 0; i < obj.length; i++) {
        //     if (obj[i].value == item) {
        //         $(obj[i]).attr("checked", "checked");
        //     }
        // }

    })

</script>
</body>
</html>
